Neurosyphilis — the infectious damage of the central nervous system caused by penetration of causative agents of syphilis into it. Can arise during any period of syphilis. Neurosyphilis is shown by symptoms of meningitis, meningovaskulyarny pathology, a meningomiyelit, defeat of back kanatik and backs of a spinal cord, progressive paralysis or focal damage of a brain in connection with education in it a syphilitic gumma. Diagnosis of neurosyphilis is based on a clinical picture, data of neurologic and ophthalmologic inspection, brain MPT and KT, positive serological reactions to syphilis and results of a research of a likvor. Treatment of neurosyphilis is carried out by intravenously high doses of medicines of penicillin.
Several decades ago neurosyphilis was very widespread complication of syphilis. However mass inspections of patients on syphilis, timely identification and treatment of the infected persons led to the fact that the modern venereology faces such form of a disease as neurosyphilis more and more seldom in spite of the fact that incidence of syphilis steadily grows. Many authors consider also that decrease in cases of neurosyphilis is connected with change of pathogenic characteristics of its activator — a pale treponema — including with decrease in its neyrotropnost.
Classification of neurosyphilis
Latent neurosyphilis has no clinical manifestations, but at a research of tserebrospinalny liquid of the patient pathological changes come to light.
Early neurosyphilis develops against the background of primary or secondary syphilis, generally in the first 2 years of a disease. But can arise within 5 years from infection time. Proceeds with defeat mainly of vessels and covers of a brain. Carry sharp syphilitic meningitis, meningovaskulyarny neurosyphilis to displays of early neurosyphilis and syphilitic meningomiyelit.
Late neurosyphilis arises not earlier than in 7-8 years from the moment of infection and corresponds to the period of tertiary syphilis. It is characterized by inflammatory and dystrophic defeat of a parenchyma of a brain: nervous cages and fibers, glia. Carry a back sukhotka, progressive paralysis and a syphilitic gumma of a brain to late forms of neurosyphilis.
Sharp syphilitic meningitis is characterized by symptoms of sharp meningitis: a severe headache, noise in ears, nausea and vomiting dizziness is not dependent on meal. Often proceeds without rise in body temperature. Positive meningialny symptoms are noted: rigidnost of muscles of a nape, lower symptom of Brudzinsky and symptoms of Kerniga. Increase in intra cranial pressure is possible. Neurosyphilis in the form of sharp meningitis develops most often in the first several years of a disease of syphilis, during its recurrence. It can be followed by skin rashes or be the only manifestation of a recurrence of secondary syphilis.
Meningovaskulyarny neurosyphilis develops at syphilitic defeat of vessels of a brain as an endarteriit. It is shown by sharp violation of blood circulation head in the form of an ischemic or hemorrhagic stroke to which for several weeks headaches, sleep disorders, dizzinesses begin to disturb the patient, changes of the personality appear. The course of meningovaskulyarny neurosyphilis with violation of spinal blood circulation and development of the lower paraparesis, disorders of sensitivity and violations from pelvic bodies is possible.
Syphilitic meningomiyelit proceeds with defeat of covers and substances of a spinal cord. Slowly accruing spastic lower paraparesis which is followed by loss of deep sensitivity and dysfunction of pelvic bodies takes place.
The back sukhotka arises owing to syphilitic inflammatory defeat and a degeneration of back backs and kanatik of a spinal cord. This form of neurosyphilis appears on average in 20 years from the infection moment. It is characterized by radiculitis with the expressed pain syndrome, loss of deep reflexes and deep types of sensitivity, a sensitive ataxy, neuro and trophic violations. At neurosyphilis in the form of a back sukhotka development of impotence is possible. Neurogenetic trophic ulcers standing and artropatiya are observed. Argayla-Robertson's syndrome — irregular shape the narrowed pupils which are not reacting to light is characteristic. The above-stated symptoms can remain also after performing specific therapy of neurosyphilis.
Progressive paralysis can develop at patients with 10-20-year of a disease. This option of neurosyphilis is connected with direct penetration pale trepony in cells of a brain with the subsequent their destruction. It is shown by gradually amplifying changes of the personality, a memory impairment, violation of thinking up to developing of dementia. Mental deviations as depressive or maniacal states, a hallucinatory syndrome, the crazy ideas are quite often observed. Neurosyphilis in the form of progressive paralysis can be followed by epileptic attacks, a dizartriya, violation of pelvic functions, an intentsionny tremor, decrease in muscular force and a tone. The combination to manifestations of a back sukhotka is possible. As a rule, patients with similar symptoms of neurosyphilis perish within several years.
The syphilitic gumma is localized most often in the brain basis that leads to a sdavleniye of backs of craniocereberal nerves with development of paresis of glazodvigatelny nerves, atrophies of optic nerves, relative deafness and so forth. In process of growth of a gumma in sizes intra cranial pressure increases and brain substance sdavleniye signs accrue. Less often the gumma at neurosyphilis settles down in a spinal cord, leading to development of the lower paraparesis and dysfunction of pelvic bodies.
Diagnosis of neurosyphilis
Establishment of the diagnosis of neurosyphilis is made taking into account 3 main criteria: a clinical picture, positive results of researches on syphilis and the revealed changes in tserebrospinalny liquid. The correct assessment of clinic of neurosyphilis is possible only after carrying out the patient by the neurologist of full neurologic inspection. Important additional information for diagnosis of neurosyphilis is given by a research of sight and inspection of an eye bottom which are performed by the oculist.
Laboratory researches on syphilis are applied in a complex and, if necessary, repeatedly. The RPR test, RIF, RIBT, detection of a pale treponema with contents of skin elements concern to them (if those are available). In the absence of brain sdavleniye symptoms to the patient with neurosyphilis the lyumbalny puncture is carried out. The research of tserebrospinalny liquid at neurosyphilis finds pale treponema, the increased protein content, inflammatory over 20 . Carrying out the REEF with a likvor, as a rule, yields positive result.
MRT of a brain and KT of a brain (or a spinal cord) at neurosyphilis find generally nonspecific pathological changes in a type of a thickening of brain covers, hydrocephaly, an atrophy of substance of a brain, heart attacks. With their help it is possible to reveal localization of a gumma and to differentiate neurosyphilis from others, similar on clinic, diseases.
Treatment of neurosyphilis
Therapy of neurosyphilis is carried out in stationary conditions by intravenous administration of high doses of medicines of penicillin within 2 weeks. The intramuscular penitsillinoterapiya does not provide sufficient concentration of an antibiotic in tserebrospinalny liquid. Therefore at impossibility of intravenous therapy intramuscular introduction of penicillin is combined with reception of a probenitsid which slows down penicillin removal by kidneys. At the patients with neurosyphilis having an allergy to penicillin apply .
In the first days of treatment of neurosyphilis there can be a temporary aggravation of neurologic symptomatology which is followed by rise in body temperature, an intensive headache, tachycardia, arterial hypotension, artralgiya. In such cases the penitsillinoterapiya of neurosyphilis is supplemented with purpose of anti-inflammatory and kortikosteroidny medicines.
Efficiency of treatment is estimated on regress of symptomatology of neurosyphilis and improvement of indicators of tserebrospinalny liquid. Control of an izlechennost of patients with neurosyphilis is carried out within 2 years by a research of tserebrospinalny liquid by each half a year. Emergence of new neurologic symptoms or increase old, and also remaining in a likvor are indications for a neurosyphilis repeated course of treatment.